This blog is meant to be a resource to individuals who have a voice disorder, people who know someone who has a voice disorder, and professionals who would like to gain more information about a client or patient who may have a voice disorder. At the end of each post, you will find a collection of other websites and journals that we think are strong resources for both patients and professionals. Please comment with opinions, experiences, and anything you would like to see covered on this site.

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Monday, April 22, 2013

Other Neurogenic Voice Disorders

Overview & Cause:

Other Neurologic Diseases may cause voice disorders or voice
problems may develop as a symptom of the following disorders:

Parkinson's Disease (PD): a degenerative
disorder of the central nervous system, symptoms include motor impairments due
to death of dopamine generating cells in the mid brain. Motor impairments
include: shaking, rigidity, slowness of initiation to start moving or
speaking. Can see tremor in the hands or entire body and gait when
walking. The voice can become dysphonic or in severe cases aphonic.The
voice may be hoarse and breathy, monopitch and monoloud.

Myasthenia Gravis (MG): chronic autoimmune
disease causing weakness and fatigue. Can affect voluntary muscles of the
body such as: the eyes, the mouth, the throat and
the limbs. Voice may be breathy, monotone. monoloudness, voice
fatigues with use- recover with rest.

Stroke (Cerebrovascular Accident CVA): limited
or no brain function due to loss of blood supply to the brain. This can be due
to Ischemia - lack of blood flow caused by, a blockage (Thrombosis or Arterial
Embolism or hemorrhage. Symptoms of strokes vary as does severity but
they include inability to move one side of the body, inability to understand or
formulate speech and inability to see one side of the visual field. Voice
qualities and problems can vary dependent on the stoke, lesion location and
severity.

Traumatic Brain Injury (TBI): this is a closed
or penetrating injury to the brain which can have varying symptoms and
outcomes. It can be widespread or focal damage. It is a major cause of
disability and death. It is more common in males than females. Voice
disorders concomitant with TBI vary depending on each patient. Often
times a voice disorder that coexists with these disorders is termed as dysarthria.

Symptoms:

Parkinson's Disease:

The following symptoms may be present:

Breathy voice

Monopitch

Monoloudness

Short, fast rushes of speech

Trouble with initiating speech

Myasthenia Gravis:

The following symptoms may be present:

Monotone

Monoloudness

Fatigue with vocal use

Amyotrophic Lateral Sclerosis:

The following symptoms may be present:

Strained and strangled sounding voice

Hyponasal vocal quality

Slow and effortful speech

Monoloudness (reduced volume)

Monopitch

Breathy voice

Stroke/CVA:

The quality of voice and symptoms depend on the location and the severity of the stoke.

Traumatic Brain Injury:

The quality of voice and symptoms depend on the location and the severity of the injury.

Treatment:

In regards to these neurogenic disorders treatment varies
depending on the person and how they are affected. The treatment given may help
the primary disease or disorder and in addition a voice treatment will be
given such as Botox injections or surgery. See the
Treatment sections on Spasmodic Dysphonia and Paralysis/Paresis for
some applicable information.

Functional Voice Therapy will be helpful for all
these types of Neurogenic Disorders- depending on the symptoms presented
voice therapy would work on: pitch, rate, timing, prosody, volume, stress (word
and sentence), word finding, vocabulary and several different
communication modalities: sign language, communication boards, Alternative
Augmentative Communication devices (AAC) would also be an option
for a patient who loses their ability to speak or if it becomes effortful
over time. You can find more information here.

Parkinson's Disease, patients with voice disorders with PD
have benefitted from the Lee Silverman Voice Treatment
(LSVT ).This treatment is specifically directed toward PD
and focuses on intensive high effort speech exercises and
increasing vocal loudness in a healthy way. For more information on
LSVT, click here.

Myasthenia Gravis (MG) can be treated in different ways. As
fatigue is an associated symptom that affect both gross motor movements and
speech productions, oral medications that reduce fatigue are helpful. ALS,
stroke & traumatic brain injury are all treated in various different ways,
as the symptoms themselves are treated depending on their severity.